{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T11:19:29Z","timestamp":1767871169048,"version":"3.49.0"},"reference-count":10,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2025,12]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n This case study presents the treatment of a 7\u00a0mm deep and 5\u00a0mm wide RT1 gingival recession on the mandibular left canine in a 30\u2010year\u2010old systemically and periodontally healthy female, with the defect being associated with a self\u2010injurious habit.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Following counseling, self\u2010injurious habit cessation, and oral hygiene reinforcement, a double papilla flap (DPF) plus subepithelial connective tissue graft (SCTG) procedure (DPF+SCTG) was performed. After de\u2010epithelialization of the gingival margin, horizontal and vertical incisions were made, and a partial\u2010thickness DPF was elevated. The SCTG was placed at the cementoenamel junction level and covered by the DPF.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Nearly complete root coverage was achieved, with recession depth reduced to 1\u00a0mm and keratinized tissue width increased from 1\u00a0mm to 6\u00a0mm. Ultrasound imaging confirmed successful graft integration and thick gingiva. At 2\u2010year follow\u2010up, creeping attachment was observed after the patient discontinued the self\u2010injurious habit, despite a prior recurrence that had caused additional trauma. The successful surgical outcome resulted in patient satisfaction, plaque control improvement, and prevention of further recession, benefiting the ongoing orthodontic treatment.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n DPF+SCTG is an effective approach for treating an isolated deep and wide RT1 recession, providing long\u2010term benefits, particularly when combined with behavior modification in patients with self\u2010injurious habits.<\/jats:p>\n <\/jats:sec>\n \n Key points<\/jats:title>\n \n \n \n \n Technique choice and patient behavior management<\/jats:bold>\n : The combination of double papilla flap and subepithelial connective tissue graft effectively achieved significant root coverage and increased keratinized tissue width in a patient with self\u2010injurious habit. However, patient behavior management was crucial in preventing recurrence.\n <\/jats:p>\n <\/jats:list-item>\n \n \n Long\u2010term stability and creeping attachment<\/jats:bold>\n : Despite a relapse due to the patient's habit, the thickened gingiva facilitated natural healing through creeping attachment, reinforcing the importance of both surgical intervention and behavioral modifications in maintaining long\u2010term stability.\n <\/jats:p>\n <\/jats:list-item>\n \n \n Ultrasound for non\u2010invasive monitoring<\/jats:bold>\n : Ultrasound imaging confirmed successful graft integration and determined tissue thickness, highlighting its potential as a non\u2010invasive periodontal healing monitoring tool.\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Plain language summary<\/jats:title>\n Gum recession is a common condition where the gum tissue pulls away from the teeth, exposing the roots and making them more prone to damage. This report describes the treatment of a 30\u2010year\u2010old woman who had severe gum recession on her lower left canine tooth, caused by her long\u2010term habit of scratching the gums with her fingernail. To restore the lost tissue and protect the tooth, a double papilla flap (a surgical technique that moves nearby tissue) along with a connective tissue graft (transplanted tissue from the roof of the mouth) was used. Over 2 years, the recession was reduced by almost 90%, and the tissue over the tooth became healthier and stronger. Although her habit caused some recession to return, the thickened tissue allowed for natural healing once she controlled her habit again. This case highlights how proper surgical technique selection and execution, combined with patient behavior changes, can successfully treat severe gum recession. It also demonstrates how ultrasound imaging can be used as a non\u2010invasive tool to monitor soft tissue healing over time.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cap.10368","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T09:54:20Z","timestamp":1750067660000},"page":"364-372","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of severe gingival recession using a double papilla connective tissue graft: A 2\u2010year follow\u2010up case study"],"prefix":"10.1002","volume":"15","author":[{"given":"Yu\u2010Chang","family":"Wu","sequence":"first","affiliation":[{"name":"Division of Periodontology The Ohio State University College of Dentistry Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Duran\u2010Garnica","sequence":"additional","affiliation":[{"name":"Division of Periodontology The Ohio State University College of Dentistry Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsun\u2010Liang","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Periodontology The Ohio State University College of Dentistry Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitris N.","family":"Tatakis","sequence":"additional","affiliation":[{"name":"Division of Periodontology The Ohio State University College of Dentistry Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/j.1600-051X.2009.01398.x","article-title":"The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva","volume":"36","author":"De Rouck T","year":"2009","journal-title":"J Clin Periodontol"},{"issue":"1","key":"e_1_2_11_3_1","first-page":"S204","article-title":"Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations","volume":"89","author":"Cortellini P","year":"2018","journal-title":"J Periodontol"},{"key":"e_1_2_11_4_1","first-page":"573","article-title":"A technique to identify and reconstruct the cementoenamel junction level using combined periodontal and restorative treatment of gingival recession. A prospective clinical study","volume":"30","author":"Cairo F","year":"2010","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1902\/jop.2004.75.5.762","article-title":"Traumatic lesions of the gingiva: a case series","volume":"75","author":"Rawal SY","year":"2004","journal-title":"J Periodontol"},{"key":"e_1_2_11_6_1","first-page":"463","article-title":"Connective tissue grafts combined with either double pedicle grafts or coronally positioned pedicle grafts: results of 266 consecutively treated defects in 200 patients","volume":"22","author":"Harris RJ","year":"2002","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/1830765","article-title":"Root coverage for single deep gingival recessions: outcomes based on a decision\u2010making algorithm","volume":"2019","author":"C\u00e9sar Neto JB","year":"2019","journal-title":"Int J Dent"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1902\/jop.1997.68.9.890","article-title":"Creeping attachment associated with the connective tissue with partial\u2010thickness double pedicle graft","volume":"68","author":"Harris RJ","year":"1997","journal-title":"J Periodontol"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1902\/jop.2016.150625","article-title":"Long\u2010term outcomes of untreated buccal gingival recessions: a systematic review and meta\u2010analysis","volume":"87","author":"Chambrone L","year":"2016","journal-title":"J Periodontol"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1002\/JPER.19-0337","article-title":"Effect of gingival phenotype on the maintenance of periodontal health: an American Academy of Periodontology best evidence review","volume":"91","author":"Kim DM","year":"2020","journal-title":"J Periodontol"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.zemedi.2023.01.005","article-title":"Overview of ultrasound in dentistry for advancing research methodology and patient care quality with emphasis on periodontal\/peri\u2010implant applications","volume":"33","author":"Rodriguez Betancourt A","year":"2023","journal-title":"Z Med Phys"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10368","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T07:04:16Z","timestamp":1767855856000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.10368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/cap.10368"],"URL":"https:\/\/doi.org\/10.1002\/cap.10368","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,16]]},"assertion":[{"value":"2025-04-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}